Admin 09/01/2023
2 Minutes

New Texas Itemized Billing Law

(S.B. 490) – Effective September 1, 2023

Posted on Friday, September 1, 2023

The new Texas itemized billing law, Senate Bill 490 (S.B. 490), is effective as of September 1, 2023.

S.B. 490 requires healthcare providers in the state of Texas to submit a written, itemized bill to each patient from whom they request payment, after providing services and/or supplies and before beginning the debt collection process.1

The itemized bill must include the following:

  1. The amount that the healthcare provider agrees to accept as full payment for each service and supply provided to the patient.

  2. A plain language description of each service or supply.

  3. The billing code(s) submitted to any third parties and the amounts billed to/paid by any third parties.1

The healthcare provider must provide the itemized bill after services/supplies have been provided and within 30 days from the date they receive final payment from a third-party payer. For uninsured or self-pay patients, the itemized bill must be provided when the healthcare provider requests payment from the patient.2

The itemized bill may be issued electronically (e.g., through a patient portal), and the patient has the right to obtain an itemized bill from the provider at any time after the itemized bill is initially issued.1

If a provider has not complied with these new requirements, the provider is prohibited from pursuing debt collection against the patient.1

Implications for Texas Healthcare Providers

The shape of the state of Texas appears along with the words: New Texas Itemized Billing Law; S.B. 490: Effective September 1, 2023.
We can help you comply with the new Texas itemized billing law, S.B. 490, and improve price transparency for your patients.

Not only is a provider prohibited from attempting to collect any payment from a patient until an itemized bill has been issued, but failure to comply with S.B. 490 can also result in disciplinary action by the appropriate licensing authority against a healthcare provider in violation of the new law.3

Healthcare providers may need to reform their billing process in order to comply with S.B. 490 and avoid disciplinary issues, while providing more price transparency to patients and improving their chances of collecting payment due.

Additionally, healthcare providers must be aware that itemized bills will contain PHI (Protected Health Information) and electronic transmission of these documents must be HIPAA-compliant.

Automating the Itemized Billing Process

Our secure, HIPAA-compliant solution, ActiveXCHANGE, can help your facility satisfy the requirements of the new Texas itemized billing law, S.B. 490.

ActiveXCHANGE can automate the extraction, reformatting, and distribution of the itemized bill to a secure print/mail center for fulfillment.

Contact us today if you’d like assistance complying with the new Texas itemized billing law, S.B. 490, and improving price transparency for your patients.


DISCLAIMER: This blog is intended for informational purposes and should not be interpreted as legal advice.


1 Hughes, B. “S.B. No. 490.” (2023). Retrieved from

2 Texas Hospital Association (THA). “FAQs on New Itemized Billing Law.” (2023). Retrieved from

3 Hughes, B. “BILL ANALYSIS: S.B. 490.” (2023). Retrieved from


By Stephanie Salmich